Articles de revues : « Graft infection »

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Betz, T., D. Neuwerth, M. Steinbauer, C. Uhl, K. Pfister et I. Töpel. « Biosynthetic vascular graft : a valuable alternative to traditional replacement materials for treatment of prosthetic aortic graft infection ? » Scandinavian Journal of Surgery 108, n^o 4 (6 décembre 2018) : 291–96. http://dx.doi.org/10.1177/1457496918816908.

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Background and Aims: To report the experience of a tertiary vascular surgery center using Omniflow II® biosynthetic vascular grafts for treatment of prosthetic aortic graft infection. Materials and methods: Retrospective analysis of all patients with prosthetic graft infections who underwent in situ aortic reconstruction using Omniflow II® grafts or other conduits between March 2015 and May 2017. Early and late mortality, perioperative complications, and reinfection rate were analyzed. Results: Sixteen patients (14 males, median age 68.5, range 57–89) with prosthetic aortic graft infection were treated at our center. Eight patients received an Omniflow II® biosynthetic graft, two patients silver-triclosan coated grafts, three patients bovine pericardial tube grafts, and three patients composite bovine pericardial tube grafts with Omniflow II® graft extensions. Perioperative complications occurred in seven patients (43.8%). Early mortality rate was 18.7% (n = 3). In addition, four patients died during follow-up after a median of 11 months (range 0–34 months). We did not observe any reinfections. Bypass grafts were patent in all patients. No major limb amputations were performed during follow-up. Conclusion: Treatment of prosthetic aortic graft infection with Omniflow II® vascular grafts is feasible. Graft material seems to have an excellent resistance to infection and might be a valuable alternative to traditional replacement materials. Especially long-term durability has to be continuously monitored and documented.

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Blank, Jacqueline J., Abby E. Rothstein, Cheong Jun Lee, Michael J. Malinowski, Brian D. Lewis, Timothy J. Ridolfi et Mary F. Otterson. « Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition ». Vascular and Endovascular Surgery 52, n^o 5 (19 mars 2018) : 386–90. http://dx.doi.org/10.1177/1538574418764037.

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Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case Report: Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Conclusions: Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

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Gwon, Jun G., Youngjin Han, Yong-Pil Cho et Tae-Won Kwon. « Obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection ». Vascular 28, n^o 5 (4 mai 2020) : 530–35. http://dx.doi.org/10.1177/1708538120922112.

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Objective Inguinal vascular graft infections are high-risk events that cannot be controlled medically but require surgical intervention. This study reviewed the long-term clinical outcomes of obturator bypass using a ringed polytetrafluoroethylene graft for inguinal graft infection. Methods A total of eight consecutive patients who underwent obturator bypass using a ringed polytetrafluoroethylene graft for inguinal prosthetic graft infection at a single medical center between January 2006 and October 2017 were retrospectively analyzed. The demographics, clinical characteristics, surgical procedure, and clinical outcomes were evaluated. Results There was no perioperative death; however, there were three operative complications. On the 1st and 9th postoperative day, two patients underwent hematoma evacuation in the pelvic cavity, and the other patient underwent suture reinforcement for partial dehiscence of the distal anastomosis on the 49th postoperative day. The median length of hospital stay was 14.5 (range, 7–29) days. Only one graft occlusion was observed at postoperative month 40; however, there were no ischemic symptoms. There were no limb amputations and postoperative deaths during the long-term follow-up period. There were no infections of the previous residual and obturator bypass grafts and inguinal infection during the follow-up period of 49 (range, 7–154) months. Conclusion Obturator bypass for inguinal graft infection is feasible and durable with excellent long-term outcomes. However, perioperative bleeding should be taken into consideration.

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Woźniak, Witold, Robert Bajno, Michał Świder et Piotr Ciostek. « The Usefulness of Biosynthetic Vascular Graft Omniflow II and Autologous Veins for the Treatment of Massive Infection of Dacron Vascular Graft with Enterococcus faecalis HLAR ». Polish Journal of Microbiology 65, n^o 4 (28 décembre 2016) : 471–74. http://dx.doi.org/10.5604/17331331.1227674.

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Infections of vascular grafts are the most severe complications in vascular surgery. We present the case of a 73-year-old male with infection of a dacron prosthesis with a strain of Enterococcus faecalis. The patient was treated with replacement of a full prosthesis with a combined graft constructed from Biosynthetic Vascular graft Omniflow and autologous veins. This graft is recommended for implantation in patients with a higher risk of infection. Our case is one of the first reported usage of this kind of graft in the aortic region and in a 2 years observation period no recurrence of infection was observed.

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Filaire, Laura, Olaf Mercier, Agathe Seguin-Givelet, Olivier Tiffet, Pierre Emmanuel Falcoz, Pierre Mordant, Pierre-Yves Brichon et al. « Superior vena cava graft infection in thoracic surgery : a retrospective study of the French EPITHOR database ». Interactive CardioVascular and Thoracic Surgery 34, n^o 3 (6 décembre 2021) : 378–85. http://dx.doi.org/10.1093/icvts/ivab337.

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Abstract OBJECTIVES To report our experience on the management of superior vena cava graft infection. METHODS Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).

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Genovese, Elizabeth A., Efthymios D. Avgerinos, Donald T. Baril, Michel S. Makaroun et Rabih A. Chaer. « Bio-absorbable antibiotic impregnated beads for the treatment of prosthetic vascular graft infections ». Vascular 24, n^o 6 (10 juillet 2016) : 590–97. http://dx.doi.org/10.1177/1708538116630859.

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Objective There is limited investigation into the use of bio-absorbable antibiotic beads for the treatment of prosthetic vascular graft infections. Our goal was to investigate the rates of infection eradication, graft preservation, and limb salvage in patients who are not candidates for graft explant or extensive reconstruction. Methods A retrospective review of patients implanted with antibiotic impregnated bio-absorbable calcium sulfate beads at a major university center was conducted. Results Six patients with prosthetic graft infections were treated with bio-absorbable antibiotics beads from 2012–2014. Grafts included an aortobifemoral, an aorto-hepatic/superior mesenteric artery, and four extra-anatomic bypasses. Pathogens included Gram-positive and Gram-negative bacteria. Half of the patients underwent graft explant with reconstruction and half debridement of the original graft, all with antibiotic bead placement around the graft. Mean follow-up was 7.3 ± 8.3 months; all patients had infection resolution, healed wounds, and 100% graft patency, limb salvage, and survival. Conclusion This report details the successful use of bio-absorbable antibiotic beads for the treatment prosthetic vascular graft infections in patients at high risk for graft explant or major vascular reconstruction. At early follow-up, we demonstrate successful infection suppression, graft preservation, and limb salvage with the use of these beads in a subset of vascular patients.

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Lehalle, B., et P. Olivier. « Graft infection ». European Journal of Vascular and Endovascular Surgery 15, n^o 6 (juin 1998) : 550. http://dx.doi.org/10.1016/s1078-5884(98)80120-2.

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Eliza, Russu, Mureşan Adrian Vasile, Cordoş Bogdan Andrei, Cotoi Ovidiu Simion et Copotoiu Constantin. « Tissue Integration of Synthetic Grafts and the Impact of Soft-Tissue Infection – An Experimental Model ». Acta Medica Marisiensis 61, n^o 4 (1 décembre 2015) : 291–97. http://dx.doi.org/10.1515/amma-2015-0097.

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AbstractObjective: Starting with the ‘Vinyon-N-revolution’ of the 50’s, there has been a constant interest in understanting tissue integration, or the so-called graft healing process, as well as its relationship with infection. In this study we present an experimental animal model designed to assess tissue integration of different graft materials, and their reaction to the presence of infection.Methods: Synthetic grafts (knitted Dacron®, woven Dacron®, silver-impregnated Dacron® and Gore-Tex®) were implanted subfascially in the interscapular region of Wistar rats. Animals were divided into a control group and an infected group, with infection induced using bacterial suspensions of standard strains of Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. Implants were retrieved at 2 and 4 weeks postoperatively in the control group and at 1, 2 and 3 weeks postoperatively in theinfected group. Retrieved grafts were assessed bacteriologically and morpho-pathologically.Results: All microorganisms produced clinically evident infections, with positive blood cultures in case of E. coli. Staphylococci produced more massive infections on Dacron® grafts, except for the silver-impregnated version, while E. coli produced more significant infections on Gore-Tex® grafts. Morpho-pathologically Dacron® grafts behaved poorly, with ocassional complete structural compromise, and no difference between the conventional and the silver-impregnated type. The Gore-Tex® graft showed a consistent structural resistance throughout the study period.Conclusions: Although the silver-impregnated graft inhibited bacterial growth, it was poorly tolerated by the host tissue. In contrast, Gore-Tex® grafts showed more massive infection, especially with E. coli, but kept their structural integrity surprisingly well.

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Seeger, James M. « Management of Patients with Prosthetic Vascular Graft Infection ». American Surgeon 66, n^o 2 (février 2000) : 166–77. http://dx.doi.org/10.1177/000313480006600213.

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Management of patients with infected prosthetic vascular grafts is one of the most difficult challenges faced by the vascular surgeon. Patients often present with nonspecific symptoms, but delay in treatment can lead to life-threatening sepsis and/or hemorrhage. Fortunately, prosthetic vascular graft infection is uncommon, with the incidence varying between 1 and 6 per cent, depending on the location of the graft. Initially, the potentially infected vascular graft should be imaged using either CT or magnetic resonance imaging, with radionuclide studies being reserved for those instances in which imaging studies do not confirm or exclude the diagnosis of infection. Current treatments for prosthetic vascular graft infection include attempted graft preservation, graft removal with in situ graft replacement (using autogenous or new prosthetic grafts), and graft removal with extra-anatomic bypass. Morbidity and mortality associated with treatment, likelihood of long-term limb salvage, and likelihood of persistent or recurrent infection vary among these types of treatment. Therefore, in an individual patient with a prosthetic vascular graft infection, many things must be considered to appropriately determine the treatment most likely to achieve eradication of the infection and long-term limb salvage with the lowest risk. Regardless, with appropriate application of the techniques currently available for treatment of prosthetic vascular graft infection, long-term elimination of infection and limb preservation can be achieved in the great majority of patients with this grave problem.

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Akoh, Jacob A., et Neil Patel. « Infection of Hemodialysis Arteriovenous Grafts ». Journal of Vascular Access 11, n^o 2 (avril 2010) : 155–58. http://dx.doi.org/10.1177/112972981001100213.

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Purpose Prosthetic arteriovenous grafts (AVG) are bedeviled by significant infectious complications. This study was to determine the infectious complications of prosthetic AVG and review the relevant literature. Methods All prosthetic AVG inserted between January 2000 to December 2007 were studied. Data on age, sex, date of graft insertion, indication for aVG, site of graft insertion, date of graft related infection, treatment and outcome for graft and patients were analyzed. Results There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates′ x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates′ x2=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series. Conclusion Infectious complications of AVG require prompt surgical or radiological intervention to save life or access. The need to excise an infected graft completely is sometimes counterbalanced by the compelling need to provide vascular access for hemodialysis in a patient with limited access options.

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Giacometti, Andrea, Oscar Cirioni, Roberto Ghiselli, Fiorenza Orlando, Federico Mocchegiani, Alessandra Riva, Maria Simona Del Prete, Vittorio Saba et Giorgio Scalise. « Efficacy of Quinupristin-Dalfopristin in Preventing Vascular Graft Infection Due to Staphylococcus epidermidis with Intermediate Resistance to Glycopeptides ». Antimicrobial Agents and Chemotherapy 46, n^o 9 (septembre 2002) : 2885–88. http://dx.doi.org/10.1128/aac.46.9.2885-2888.2002.

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ABSTRACT A rat model was used to investigate the efficacy of quinupristin-dalfopristin (Q-D) in the prevention of vascular prosthetic graft infection due to methicillin-resistant Staphylococcus epidermidis with intermediate resistance to glycopeptides. The in vitro activity of the compound was compared to that of vancomycin by MIC determination and time-kill study. Moreover, the efficacy of collagen-sealed Q-D-soaked Dacron was evaluated in a rat model of graft infection. Graft infections were established in the subcutaneous tissue of the backs of 120 adult male Wistar rats. The in vivo study included a control group, one contaminated group that did not receive any antibiotic prophylaxis, two contaminated groups that received grafts soaked with 10 and 100 μg of Q-D per ml, respectively, and two contaminated groups that received grafts soaked with 10 and 100 μg of vancomycin per ml, respectively. Rats that received Dacron grafts soaked with 100 μg of Q-D per ml showed no evidence of infection (<10 CFU/ml). In contrast, for rats that received Dacron grafts soaked with 10 μg of Q-D per ml and Dacron grafts soaked with 10 or 100 μg of vancomycin per ml, the quantitative graft cultures demonstrated 2.2 × 102 ± 1.3 × 102, 2.2 × 106 ± 1.9 × 105, and 5.6 × 102 ± 0.3 × 102 CFU/ml, respectively. Taken together the results of the study demonstrate that the use of Dacron grafts soaked with Q-D can result in significant bacterial growth inhibition and show that this compound is potentially valuable for prevention of vascular prosthetic graft infection.

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Matsuura, John H., David Rosenthal, Eric D. Wellons, Clare S. Castronovo et David Fronk. « Hemodialysis Graft Infections Treated with Cryopreserved Femoral Vein ». Cardiovascular Surgery 10, n^o 6 (décembre 2002) : 561–65. http://dx.doi.org/10.1177/096721090201000608.

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Introduction: Treatment of infected hemodialysis grafts is associated with prolonged hospitalization and wound care. The use of cryopreserved femoral vein (CFV) for angioaccess in infected hemodialysis grafts was prospectively evaluated. Methods: Forty-three CFV arteriovenous grafts (AVGs) were placed in 43 patients with prosthetic AVG infections. Thirty-two of the CFV AVGs were constructed adjacent to the infected AVG using a parallel tunnel tract, while 11 were placed into the infected field. All patients were prospectively followed at three-month intervals for graft complications and recurrent infections. Results: With a mean follow-up of 418 days, there was one recurrent infection (2.3%). The one-year primary and secondary graft patency rates were 42% and 68%, respectively. The two-year primary and secondary patency rates were 31% and 63%. respectively. Conclusions: Cryopreserved femoral vein proved useful in the treatment of infected hemodialysis grafts. The absence of infection after implantation around an infected area shows promise for salvaging an angioaccess site that would otherwise have been abandoned.

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Davidovic, Lazar, Ilija Kuzmanovic, Dusan Kostic, Ilijas Cinara, Slobodan Cvetkovic, Miljko Ristic, Dusan Velimirovic et Dragica Jadranin. « Obturator or "lateral" bypass in the management of infected vascular prostheses at the groin ». Srpski arhiv za celokupno lekarstvo 130, n^o 1-2 (2002) : 27–32. http://dx.doi.org/10.2298/sarh0202027d.

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The infection of the previously implanted vascular graft at the groin, is associated with great mortality and morbidity rate [1]. The authors present a retrospective study in which they analyzed management of infected vascular prostheses at the groin, using obturator bypass in 26 cases, and "lateral" bypass in 15 cases. The indications for obturator bypass reconstructions included: 20 infections of aorto-femoral grafts, two infected pse udoaneurysms in the groin after RTA of the superficial femoral artery, and 4 infections of iliac-femoral grafts. The indications for lateral bypass reconstructions were: infections after aorto-femoral reconstructions - 8 cases; infection after femora-popliteal reconstructions - 4 cases; infection after iliac-femoral reconstruction - 2 patients, and one infected pseudoaneurysm in the groin after RTA of the superficial femoral artery. In 3 subjects obturator bypass was performed using extraperitoneal approach while in other 23 patients transperitoneal approach was done by donor's artery. The obturator bypass was performed using a PTFE graft in 3 cases and Dacron graft in 23. The donor's artery used for obturator bypass was a noninfected proximal part of aortofemoral graft in 20 cases, and iliac artery in 6 patients. The superfical femoral artery was recipient artery for obturator bypass in 3 cases, deep femoral artery in one case, and above the knee popliteal artery in 22 cases (Figure 1). In two patients transperitoenal approach to donors artery for "lateral" bypass has been used, and in 13 cases extraperitoneal. The proximal noninfected part of aorto femoral graft was used as a donor's artery for lateral bypass in 8 patients, while common iliac artery in 7 subjects. In 5 cases recon structions were performed using PTFE grafts, in 3 using autologous saphenous vein grafts, and in 7 using Dacron grafts. The recipient artery for "lateral" bypass was deep femoral in 8 cases, superficial femoral in three patients and above the knee popliteal artery in 4 subjects. After both types of reconstruction, extirpation of infected grafts from the groin was performed (Figure 2). The control examination was performed using physical and Doppler ultrasonographic examinations, one, 3, 6, 12 months, and then every year after the operation. In cases with suspected graft infection or thrombosis, control angography was also performed. One intraoperative perforation of the urinary bladder has been done accidentally during obturator bypass reconstruction. The mean follow-up period for patients with obturator bypasses was 2.3 years, while 2.1 years for patients with "lateral" bypasses. Comparing with "lateral" bypass, obturator bypass showed statistically significant lower (p < 0.05) 30- day mortality and early graft infection rate, as well as statistically significant better early and total limb salvage rate. There were no statistically significant differences (p > 0.05) between obturator and "lateral" bypass procedures having in mind, late graft infection rate, as well as early and late graft patency (Figures 3 and 4). In cases with infected vascular prostheses in the groin, the authors recommend obturator bypass comparing with "lateral" bypass.

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Molacek, Jiri, Vladislav Treska, Karel Houdek, Václav Opatrný, Bohuslav Certik et Jan Baxa. « Use of a Silver-Impregnated Vascular Graft : Single-Center Experience ». Antibiotics 11, n^o 3 (15 mars 2022) : 386. http://dx.doi.org/10.3390/antibiotics11030386.

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Introduction: Vascular graft infection is a life threatening situation with significant morbidity and mortality. Bacterial graft infection can lead to false aneurysms, bleeding and sepsis. There are a lot of risky situations where grafts can become infected. It is therefore highly desirable to have a vascular graft that is resistant to infection. In this retrospective clinical study, a silver-impregnated vascular graft was evaluated in various indications. Methods: Our study included a total of 71 patients who received a silver-impregnated vascular graft during the period from 2013 to 2018. Patients had an aortoiliac localization of vascular graft in 61 cases (86%), and a peripheral localization on the lower limbs in 10 cases (14%). Indications for the use of these special vascular grafts were trophic lesions or gangrene in the lower limbs in 24 cases (34%), suspicious mycotic abdominal aortic aneurysm (mAAA) in 4 cases (5.5%), salmonela aortitis or aneurysms in 4 cases (5.5%), infection of the previous vascular graft in 11 cases (15.5%), other infections in 12 cases (17%), AAA rupture in 10 cases (14%) and other reasons (pre-transplant condition, multiple trauma, graft-enteric fistula) in 6 cases (8.5%). Thirty-day mortality, morbidity, the need for reintervention and amputation, primary and secondary graft patency, and finally the presence of a proven vascular graft infection were evaluated. Results: The 30-day mortality was 19.7%, and morbidity was 42.2%. The primary patency of the vascular graft was 91.5%. Reoperation was necessary in 10 cases (14%) and amputation was necessary in 10 cases (14%). The median length of hospital stay was 13 days and the mean follow-up period was 48 ± 9 months. During the follow-up period, six patients (8.5%) died from reasons unrelated to surgery or without any relation to the vascular graft. Secondary patency after one year was 88%. Infection of the silver graft was observed in three patients (4.2%). Conclusions: Based on our results, the silver graft is a very suitable alternative for solving infectious, or potentially infectious, situations in vascular surgery. In particular, in urgent or acute cases, a silver graft is often the only option.

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Zegelman, Max, Gisela Guenther, Matthias Waliszewski, Fryderyk Pukacki, Michal Goran Stanisic, Philippe Piquet, Marius Passon et al. « Results from the International Silver Graft Registry for high-risk patients treated with a metallic-silver impregnated vascular graft ». Vascular 21, n^o 3 (13 mai 2013) : 137–47. http://dx.doi.org/10.1177/1708538113478773.

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The purpose of this postmarket surveillance registry was to document the efficacy of a vascular prosthesis coated with metallic silver in high-risk patients undergoing vascular reconstructions. Patency (primary endpoint) and freedom from graft infection (secondary endpoint) data were assessed at a minimum of 12 months in patients with significant co-morbidity and/or confirmed graft infections or infected native vessels. Between November 2006 and December 2009, 230 patients with high-risk factors underwent aortic, peripheral and/or extra-anatomic reconstructions with Silver Graft® (SG) in six German, one French and one Polish vascular center. All participating centers used the metallic silver-coated polyester graft (SG) in various diameters and lengths including tubular and bifurcate vascular grafts. Doppler ultrasound follow-ups to determine graft patency were planned at 12 months or done at an earlier time in case the patient became symptomatic. A total of 230 patients were studied. Ten of these 230 patients had graft infections at baseline whereas the remaining 220 subjects had significant risk factors such as coronary artery disease (62.7%, 138/220), vascular access in scar tissue (27.3%, 60/220), Fontaine III/IV (38.2%, 84/220), chronic renal insufficiency (26.8%, 59/220) and diabetes (21.0%, 46/220). The long-term follow-up at 15.5 ± 8.3 months revealed a secondary patency rate of 93.2% (205/220) and an ‘all cause’ mortality rate of 18.6% (41/220). There was a freedom from de novo graft infection rate of 95.9% (211/220) in the high-risk group without graft infections at baseline. One regraft infection occurred distal of the revisional reconstruction in the 10 patients with graft infection at baseline. The presence of perigraft fluid at follow-up and Fontaine III/IV at baseline were found to be predictors for graft patency whereas perigraft fluid presence was the only predictor for de novo graft infections. This registry revealed favorable patency and freedom from de novo infections rates in a ‘high-risk’ population with significant co-morbidities.

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Iqbal, Rabia, Deepti Bhandare, Myron St Louis et Rupam Ruchi. « Think before you leap : cutaneous hypersensitivity to polytetrafluoroethylene arteriovenous graft masquerading as infection ». BMJ Case Reports 12, n^o 9 (septembre 2019) : e230401. http://dx.doi.org/10.1136/bcr-2019-230401.

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Polytetrafluoroethylene (PTFE) graft is a synthetic graft commonly used in chronic haemodialysis patients. Expected complications of synthetic grafts include infection, thrombosis, oedema and pain. PTFE is a non-textile graft that is chemically inert, electronegative and hydrophobic. Due to their chemical properties, PTFE grafts have lower risks of these adversities. We present a patient with a rare case of cutaneous hypersensitivity to a PTFE graft.

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Giacometti, Andrea, Oscar Cirioni, Roberto Ghiselli, Luigi Goffi, Federico Mocchegiani, Alessandra Riva, Giorgio Scalise et Vittorio Saba. « Polycationic Peptides as Prophylactic Agents against Methicillin-Susceptible or Methicillin-Resistant Staphylococcus epidermidis Vascular Graft Infection ». Antimicrobial Agents and Chemotherapy 44, n^o 12 (1 décembre 2000) : 3306–9. http://dx.doi.org/10.1128/aac.44.12.3306-3309.2000.

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ABSTRACT Several polycationic peptides isolated from animals, plants, and bacterial species possess a broad spectrum of antimicrobial activity. A rat model was used to investigate the efficacies of two peptides, ranalexin and buforin II, in the prevention of vascular prosthetic graft infections. The effect of peptide-soaked collagen-sealed Dacron was compared to that of rifampin-soaked collagen-sealed Dacron in the rat model of graft infection caused by methicillin-susceptible rifampin-susceptible Staphylococcus epidermidis and methicillin-resistant rifampin-susceptible S. epidermidis. Graft infections were established in the back subcutaneous tissue of 240 adult male Wistar rats by implantation of 1-cm2 Dacron prostheses, followed by topical inoculation with 2 × 107 CFU of S. epidermidis. The study included a control group (no graft contamination), two contaminated groups that did not receive any antibiotic prophylaxis, two contaminated groups to which perioperative intraperitoneal cefazolin prophylaxis (30 mg/kg of body weight) was administered, six contaminated groups that received a peptide- or rifampin-soaked graft, and six contaminated groups that received a peptide- or rifampin-soaked graft and perioperative intraperitoneal cefazolin prophylaxis (30 mg/kg). The grafts were sterilely removed 7 days after implantation, and the infection was evaluated by using sonication and quantitative agar culture. Overall, the efficacies of the polycationic peptides against the methicillin-susceptible and methicillin-resistant strains were not significantly different from that of rifampin. Nevertheless, the combinations of ranalexin- and buforin II-coated grafts with cefazolin treatment demonstrated efficacies significantly higher than that of the combination of rifampin-coated grafts and cefazolin treatment against the methicillin-resistant strain.

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Krasznai, AG, MGJ Snoeijs, MP Siroen, T. Sigterman, A. Korsten, FL Moll et LH Bouwman. « Treatment of aortic graft infection by in situ reconstruction with Omniflow II biosynthetic prosthesis ». Vascular 24, n^o 6 (9 juillet 2016) : 561–66. http://dx.doi.org/10.1177/1708538115621195.

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Currently available conduits for in situ reconstruction after excision of infected aortic grafts have significant limitations. The Omniflow II vascular prosthesis is a biosynthetic graft associated with a low incidence of infection that has succesfully been used in the treatment of infected infrainguinal bypass. We report on the first use of the Omniflow II prosthesis for in situ reconstruction after aortic graft infection. A bifurcated biosynthetic bypass was created by spatulating and anastomosing two 8-mm tubular Omniflow II grafts. This bypass was used for in situ reconstruction after excision of infected aortic grafts in three cases. After a mean follow-up of 2.2 years, no occlusion, degeneration, or rupture of the Omniflow II grafts was observed. Although one patient suffered from graft reinfection, the bypass retained structural integrity and no anastomotic dehiscence was observed. Treatment of aortic graft infection by in situ reconstruction with the Omniflow II vascular prosthesis is feasible. Its resistance to infection and off-the-shelf availability make this graft a promising conduit for aortoiliac reconstruction.

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Golan, John F. « Vascular Graft Infection ». Infectious Disease Clinics of North America 3, n^o 2 (juin 1989) : 247–58. http://dx.doi.org/10.1016/s0891-5520(20)30261-0.

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Ratliff, Catherine R., David Strider, Tanya Flohr, Danielle Moses, Virginia Rovnyak, Julie Armatas, Jennifer Johnson et al. « Vascular Graft Infection ». Journal of Wound, Ostomy and Continence Nursing 44, n^o 6 (2017) : 524–27. http://dx.doi.org/10.1097/won.0000000000000376.

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Bandyk, Dennis F., et Glenn E. Esses. « Prosthetic Graft Infection ». Surgical Clinics of North America 74, n^o 3 (juin 1994) : 571–90. http://dx.doi.org/10.1016/s0039-6109(16)46330-9.

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Ladizinski, Barry, et Christopher Sankey. « Aortic Graft Infection ». Journal of General Internal Medicine 29, n^o 10 (24 avril 2014) : 1419–20. http://dx.doi.org/10.1007/s11606-014-2838-5.

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Matic, Predrag, Slobodan Tanaskovic, Rastko Zivic, Dario Jocic, Predrag Gajin, Srdjan Babic, Ivan Soldatovic, Goran Vucurevic, Dragoslav Nenezic et Djordje Radak. « Negative-pressure wound therapy for deep groin vascular infections ». Srpski arhiv za celokupno lekarstvo 144, n^o 11-12 (2016) : 621–25. http://dx.doi.org/10.2298/sarh1612621m.

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Introduction. Infection of synthetic graft in the groin is a rare but devastating complication. When it occurs, several possibilities of treatment are available. Extra-anatomic reconstruction and in-situ implantation of new, infection resistant grafts are associated with high mortality and morbidity. Therefore, more conservative approach is needed in some cases. Negative-pressure wound therapy is one of the options in treating such patients. Objective. The aim of this study was to assess the outcome for deep groin vascular graft infection treated with negative-pressure wound therapy. Methods. Seventeen patients (19 wounds), treated for Szilagyi grade III groin infections between October 2011 and June 2014, were enrolled into this observational study. Results. Majority of the wounds (11/19) were healed by secondary intention, and the rest of the wounds (8/19) were healed by primary intention after initial negative-pressure wound therapy and graft substitution with silver-coated prostheses or autologous artery/vein implantation. No early mortality was observed. Minor bleeding was observed in one patient. Reinfection was noted in three wounds. Only one graft occlusion was noted. Late mortality was observed in three patients. Conclusion. Negative-pressure wound therapy seems to be safe for groin vascular graft infections and comfortable for both patient and surgeon. However, the rate of persistent infection is high. This technique, in our opinion, can be used as a ?bridge? from initial wound debridement to definitive wound management, when good local conditions are achieved for graft substitution, either with new synthetic graft with antimicrobial properties or autologous artery/vein. In selected cases of deep groin infections it can be used as the only therapeutic approach in wound treatment.

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Offerhaus, Christoph, Jürgen Höher et Maurice Balke. « Pre-soaking of hamstring grafts reduces risk of infection after ACL-reconstruction. A prospective study including 1000 patients ». Orthopaedic Journal of Sports Medicine 6, n^o 4_suppl2 (1 avril 2018) : 2325967118S0003. http://dx.doi.org/10.1177/2325967118s00036.

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Post-operative infection of the knee is one of the major concerns following ACL-reconstruction. The purpose of this study was to investigate whether the pre-soaking of hamstring grafts in vancomycin reduces the incidence of post-operative infection. This prospective study included more than 1000 patients undergoing primary ACL-reconstruction over a period of 4 years. Group 1 received intra-operative iv-antibiotics without pre-soaking of the graft. Group 2 received iv-antibiotics and additionally the graft was bathed in a vancomycin solution of 5 mg/mL. In group 1, a total of 2,3% of the patients suffered a post-operative joint infection. In contrast, there were no post-operative infections in the second group (0%). Statistical analysis revealed a significantly reduced post-operative infection rate when bathing the autograft in vancomycin. Pre-soaking of hamstrings grafts with vancomycin combined with classical iv antibiotic prophylaxis reduced the rate of post-operative infection when compared to iv-antibiotics alone. This technique should be utilized to reduce the overall incidence of knee infections following ACL reconstruction.

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Miyake, Keisuke, Katsukiyo Kitabayashi et Nobuo Sakagoshi. « Results of Graft Removal and Negative Pressure Wound Therapy in Management of Graft Infection ». International Journal of Angiology 28, n^o 01 (2 janvier 2019) : 039–43. http://dx.doi.org/10.1055/s-0038-1676798.

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AbstractGraft infections are a challenging complication in lower extremity bypass surgery with poor outcome, even when treated with graft removal (Gr-R) as a gold standard therapy. The efficacy of negative pressure wound therapy (NPWT) for graft infections has been reported recently, but it is still controversial. The purpose of this study was to assess the efficacy of NPWT and Gr-R for treating graft infections. Twelve consecutive patients with graft infections from 2008 to 2014, treated with Gr-R or NPWT, were enrolled. Those procedures were assessed in complete wound healing, reinfection, amputation, and mortality rate. Five grafts were treated with Gr-R, and seven grafts with NPWT. The initial indications for bypass surgery were claudication, in five grafts treated with Gr-R and three grafts treated with NPWT, and critical limb ischemia in four grafts treated with NPWT. The median time until healing in Gr-R and NPWT was 12 and 59 days, with complete healing seen in 100 and 85.7%, respectively. The major amputation rate was 20 and 14.3%, and reinfection rate was 20 and 14.3%, respectively. There was no perioperative mortality. Gr-R did not show devastating outcome when applied for grafts without limb-threatening ischemia. NPWT showed a low level of invasiveness with excellent results, except for anastomosis site infections. To achieve optimal results, a tailored treatment strategy should be considered.

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Streblow, Daniel N., Craig Kreklywich, Qiang Yin, V. T. De La Melena, Christopher L. Corless, Patricia A. Smith, Christina Brakebill et al. « Cytomegalovirus-Mediated Upregulation of Chemokine Expression Correlates with the Acceleration of Chronic Rejection in Rat Heart Transplants ». Journal of Virology 77, n^o 3 (1 février 2003) : 2182–94. http://dx.doi.org/10.1128/jvi.77.3.2182-2194.2003.

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ABSTRACT Cytomegalovirus (CMV) infections have been shown to dramatically affect solid organ transplant graft survival in both human and animal models. Recently, it was demonstrated that rat CMV (RCMV) infection accelerates the development of transplant vascular sclerosis (TVS) in both rat heart and small bowel graft transplants. However, the mechanisms involved in this process are still unclear. In the present study, we determined the kinetics of RCMV-accelerated TVS in a rat heart transplant model. Acute RCMV infection enhances the development of TVS in rat heart allografts, and this process is initiated between 21 and 24 days posttransplantation. The virus is consistently detected in the heart grafts from day 7 until day 35 posttransplantation but is rarely found at the time of graft rejection (day 45 posttransplantation). Grafts from RCMV-infected recipients had upregulation of chemokine expression compared to uninfected controls, and the timing of this increased expression paralleled that of RCMV-accelerated neointimal formation. In addition, graft vessels from RCMV-infected grafts demonstrate the increased infiltration of T cells and macrophages during periods of highest chemokine expression. These results suggest that CMV-induced acceleration of TVS involves the increased graft vascular infiltration of inflammatory cells through enhanced chemokine expression.

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Zientara, Alicja, Igor Schwegler, Omer Dzemali, Hans Bruijnen, Andreas Sebastian Peters et Nicolas Attigah. « Xenopericardial self-made tube grafts in infectious vascular reconstructions : Preliminary results of an easy and ready to use surgical approach ». Vascular 24, n^o 6 (9 juillet 2016) : 621–27. http://dx.doi.org/10.1177/1708538116644361.

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Purpose Infections are a major setback of vascular reconstruction and associated with considerable morbidity and mortality. We evaluated retrospectively our results with self-made bovine pericardial grafts in infected vessel revascularization versus standard graft material. Basic methods Retrospective analysis of 9 patients with bovine reconstruction and 10 patients with miscellaneous grafts (vein, homograft) for vascular infections. Principal findings Infection-free rate of the pericardial group was 100% in 17 months. For patients after reconstructions with miscellaneous grafts, the infection-free rate was 82% in 45 months. Overall in-hospital mortality was 10.5%. There were no in-hospital deaths in the pericardial group. Graft patency of the whole cohort was 100%. The median follow up was 11.74 months. Conclusion Self-made bovine pericardial tube grafts can be crafted to almost any size and adjusted to complex anatomic requirements. The use was feasible in various situations and was associated with good preliminary results concerning patency and reinfection.

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Megaloikonomos, Panayiotis D., Thekla Antoniadou, Leonidas Dimopoulos, Marcos Liontos, Vasilios Igoumenou, Georgios N. Panagopoulos, Efthymia Giannitsioti, Andreas Lazaris et Andreas F. Mavrogenis. « Spondylitis transmitted from infected aortic grafts : a review ». Journal of Bone and Joint Infection 2, n^o 2 (19 janvier 2017) : 96–103. http://dx.doi.org/10.7150/jbji.17703.

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Abstract. Graft infection following aortic aneurysms repair is an uncommon but devastating complication; its incidence ranges from <1% to 6% (mean 4%), with an associated perioperative and overall mortality of 12% and 17.5-20%, respectively. The most common causative organisms are Staphylococcus aureus and Escherichia coli; causative bacteria typically arise from the skin or gastrointestinal tract. The pathogenetic mechanisms of aortic graft infections are mainly breaks in sterile technique during its implantation, superinfection during bacteremia from a variety of sources, severe intraperitoneal or retroperitoneal inflammation, inoculation of bacteria during postoperative percutaneous interventions to manage various types of endoleaks, and external injury of the vascular graft. Mechanical forces in direct relation to the device were implicated in fistula formation in 35% of cases of graft infection. Partial rupture and graft migration leading to gradual erosion of the bowel wall and aortoenteric fistulas have been reported in 30.8% of cases.Rarely, infection via continuous tissues may affect the spine, resulting in spondylitis. Even though graft explantation and surgical debridement is usually the preferred course of action, comorbidities and increased perioperative risk may preclude patients from surgery and endorse a conservative approach as the treatment of choice. In contrast, conservative treatment is the treatment of choice for spondylitis; surgery may be indicated in approximately 8.5% of patients with neural compression or excessive spinal infection. To enhance the literature, we searched the related literature for published studies on continuous spondylitis from infected endovascular grafts aiming to summarize the pathogenesis and diagnosis, and to discuss the treatment and outcome of the patients with these rare and complex infections.

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Marom, Niv, Milan Kapadia, Joseph T. Nguyen, Brittany Ammerman, Caroline Boyle, Isabel Wolfe, Kristin C. Halvorsen et al. « Factors Associated With an Intra-articular Infection After Anterior Cruciate Ligament Reconstruction : A Large Single-Institution Cohort Study ». American Journal of Sports Medicine 50, n^o 5 (14 mars 2022) : 1229–36. http://dx.doi.org/10.1177/03635465221078311.

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Background: An intra-articular infection after anterior cruciate ligament (ACL) reconstruction (ACLR) is a rare complication but one with potentially devastating consequences. The rare nature of this complication raises difficulties in detecting risk factors associated with it and with worse outcomes after one has occurred. Purpose: To (1) evaluate the association between an infection after ACLR and potential risk factors in a large single-center cohort of patients who had undergone ACLR and (2) assess the factors associated with ACL graft retention versus removal. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLR procedures performed at our institution between January 2010 and December 2018 were reviewed; a total of 11,451 procedures were identified. A retrospective medical record review was performed to determine the incidence of infections, patient and procedure characteristics associated with an infection, infection characteristics, incidence of ACL graft retention, and factors associated with the retention versus removal of an ACL graft. Multivariable logistic regression analysis was used to identify potential risk factors for an infection after ACLR. Results: Of the 11,451 ACLR procedures, 48 infections were identified (0.42%). Multivariable logistic regression analysis revealed revision ACLR (odds ratio [OR], 3.13 [95% CI, 1.55-6.32]; P = .001) and younger age (OR, 1.06 [95% CI, 1.02-1.10]; P = .001) as risk factors for an infection. Compared with bone–patellar tendon–bone autografts, both hamstring tendon autografts (OR, 4.39 [95% CI, 2.15-8.96]; P < .001) and allografts (OR, 5.27 [95% CI, 1.81-15.35]; P = .002) were independently associated with an increased risk of infections. Overall, 15 ACL grafts were removed (31.3%). No statistically significant differences besides the number of irrigation and debridement procedures were found for retained versus removed grafts, although some trends were identified ( P = .054). Conclusion: In a large single-center cohort of patients who had undergone ACLR and those with an infection after ACLR, patients with revision cases and younger patients were found to have a higher incidence of infection. The use of bone–patellar tendon–bone autografts was found to be associated with the lowest risk of infection after ACLR compared with both hamstring tendon autografts and allografts. Larger cohorts with a larger number of infection cases are needed to determine the factors associated with graft retention versus removal.

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Min Kim, Suh, Seung-Kee Min, Sanghyun Ahn, Sang-Il Min, Jongwon Ha et Jung Kee Chung. « How to treat arteriovenous graft infection : total versus partial graft excision ». Journal of Vascular Access 19, n^o 2 (19 février 2018) : 125–30. http://dx.doi.org/10.5301/jva.5000820.

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Introduction: Arteriovenous graft (AVG) infection can result in life-threatening sepsis and loss of vascular access. A retrospective study was performed to establish an appropriate treatment strategy for AVG infection. Methods: A total of 50 cases of AVG infection were treated between January 2005 and June 2016. The surgical methods used were total graft excision (TGE) (n = 34), or partial graft excision (PGE) with interposition graft (n = 16). Results: Infection was noted at a puncture site (n = 22), a prior incision for surgery or endovascular therapy (n = 20), and abandoned (currently unused) grafts (n = 5). Infection occurred within 1 month after AVG creation (n = 1), or any intervention (n = 14), and more than 1 month after creation or intervention (n = 35). Simultaneous remote infection was identified in 7 patients, 2 of whom underwent an operation for infective endocarditis and spondylitis. After PGE, 5 patients (5/16, 31.2%) having recurrent infection were treated with further graft excision; however, no patient showed life-threatening complications. After TGE, a central venous catheter (CVC) was inserted and used for a median period of 90 days. Among 34 patients who underwent TGE, new vascular access was created in 18 patients at a median period of 2 months later, and 12 patients continued to use a CVC until last follow-up or death. Conclusions: PGE could be a treatment option for AVG infection to achieve both infection eradication and vascular access preservation in selected patients. Because of a higher risk of recurrent infection, sufficient surgical removal and careful postoperative management are warranted.

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Fischer, Peter E., Timothy C. Fabian, Waldemar G. Derijk, Norma M. Edwards, Michael Decuypere, Ryan M. Landis, Danielle L. Barnard, Louis J. Magnotti et Martin A. Croce. « Prosthetic Vascular Conduit in Contaminated Fields : A New Technology to Decrease ePTFE Infections ». American Surgeon 74, n^o 6 (juin 2008) : 524–29. http://dx.doi.org/10.1177/000313480807400611.

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Vascular reconstruction using prosthetic materials in contaminated fields can lead to infection, graft loss, and subsequent amputation. We hypothesized that minocycline and rifampin bound to an ePTFE graft using a unique methacrylate technology would provide for resistance from infection and controlled antibiotic elution. Kirby Bauer susceptibility testing was performed on plates overlaid with Staph aureus (SA) and Staph epidermidis (SE) using 6 mm diameter discs of uncoated graft or antibiotic coated graft (ABX). Zones of inhibition (ZIH) were determined after 24 hours. ABX grafts were then placed in a continuous water bath and a recirculating, pulsatile flow device. Susceptibility testing and high performance liquid chromatography with mass spectroscopy was performed to determine graft performance and antibiotic elution rate. ABX grafts had an average ZIH of 35 mm for SA and 44 mm for SE (each P < 0.0001). After the 1 week water bath, the ZIH of the ABX grafts was 23 mm on both the SA and SE plates. The high performance liquid chromatography with mass spectroscopy revealed that after 24 hours, 50 per cent of the antibiotics remained on the graft, and there was a sustained elution for 7 days. Minocycline and rifampin can be bound to ePTFE vascular grafts using a unique methacrylate method. In vitro, the grafts provide a slow elution of antibiotics that provide resistance from infection by SA and SE for up to 2 weeks after graft insertion.

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Bachleda, Petr, Lucie Kalinová, Monika Váchalová et Pavel Koranda. « Unused Arteriovenous Grafts as a Source of Chronic Infection in Haemodialysed Patients with Relevance to Diagnosis of Fluorodeoxyglucose PET/CT Examination ». Annals of the Academy of Medicine, Singapore 41, n^o 8 (15 août 2012) : 335–38. http://dx.doi.org/10.47102/annals-acadmedsg.v41n8p335.

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Introduction: Clotted arteriovenous grafts (AVG) for haemodialysis which are not used (silent grafts) can serve as a potential source of chronic bacterial infection in patients on dialysis programs. In some cases, the local finding is unclear. The patient only suffers from repeated metastatic infection and the detection of AVG infection is difficult. Nuclear medicine methods have the potential to uncover AVG infection. In this study, we correlated the positron emission tomography (PET)/ computed tomography (CT) findings of the AVG examination with the microbiological findings from removed grafts. The aim was to evaluate the relevance of the Fluorodeoxyglucose (FDG) PET/CT method in detecting clotted graft infection. Material and Methods: A cohort of 13 patients with clotted grafts were followed-up. Four patients had overall symptoms of infection and 9 patients were asymptomatic. In all cases, the PET CT examination and microbiological examination of the removed graft were provided. Results: Only one mismatch—negative PET CT finding and positive microbiological culture was recorded in the 13 followed-up patients. Conclusion: In patients with silent grafts and recurrent infection of equivocal aetiology, PET CT examination can contribute to the diagnosis of AVG infection and, subsequently, to prevent further infectious complications, if the AVG infection is treated appropriately and the graft is removed. Key words: ePTFE prosthesis, Nuclear medicine imaging, Staphylococcus aureus, Vascular access infection

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Leon, Luis R., Janice Thai et John P. Pacanowski. « Gram-negative groin sepsis treated with covered stents and systemic antibiotics ». Vascular 19, n^o 4 (22 juillet 2011) : 226–31. http://dx.doi.org/10.1258/vasc.2010.cr0255.

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Prosthetic graft infections are hazardous conditions. Those due to Gram-negative bacteria are particularly serious. When Gram-negative microorganisms are present, entire graft excision is recommended, with revascularization if needed, preferably with autogenous tissues or with prosthetic grafts via non-infected planes if autogenous options are not available. We herein report the case of a diabetic man with critical limb ischemia, who after lower-extremity revascularization with a prosthetic graft, developed an early graft infection due to Gram-negative and fungal organisms, and who was successfully treated with a covered stent placed across grossly infected tissues. A discussion on the pertinent literature is also offered.

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Shamrock, Alan, William Cates, Robert Cates, qiang an, Brian Wolf, Matthew Bollier, Kyle Duchman et Jacqueline Baron Robert Westermann. « Graft Preparation with Intraoperative Vancomycin Decreases Infection after Anterior Cruciate Ligament Reconstruction : A Review of 1640 Cases ». Orthopaedic Journal of Sports Medicine 8, n^o 7_suppl6 (1 juillet 2020) : 2325967120S0050. http://dx.doi.org/10.1177/2325967120s00506.

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Objectives: Septic arthritis is a rare but devastating complication following anterior cruciate ligament (ACL) reconstruction. Reported infection rates following ACL reconstruction are low, but associated with high morbidity including reoperation and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with vancomycin irrigant. Methods: All ACL reconstructions performed from May 2009-August 2018 at a single, large academic institution were reviewed and categorized based on vancomycin use. Those with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days of ACL reconstruction. Descriptive and inferential statistical analysis using t-tests and Poisson regression were performed, with statistical significance defined as p<0.05. Results: In total, 1,640 patients (952 males; 58.0%) with a mean age of 27.7 + 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%) while 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. There were eleven total infections (0.7%), with ten infections occurring in patients without vancomycin-soaked grafts (1.2%) and one infection occurring in grafts soaked in vancomycin (0.1%; p=0.008). Age (p=0.571), gender (p=0.707), smoking (p=0.407), surgeon (p=0.124), and insurance type (p=0.616) were not associated with postoperative infection. There was an 89.5% relative risk reduction with the use of intraoperative vancomycin. Increased body mass index (BMI) (p=0.029), increased operative time (p=0.001), and absence of ACL graft preparation with vancomycin (p=0.032) independently predicted postoperative infection. Conclusion: The use of vancomycin-soaked grafts was associated with a ten-fold reduction in postoperative infection after ACL reconstruction (0.1% versus 1.2%; p=0.032). Other risk factors for postoperative infection after ACL reconstruction included increased BMI and increased operative time. [Table: see text][Table: see text][Table: see text][Table: see text]

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Laitinen, J., J. Lehtonen, I. Soini, I. Toivio, R. Mokka et M. Vorne. « 99mTc-Leukocyte Scintigraphy in Prosthetic Vascular Graft Infections ». Nuklearmedizin 28, n^o 03 (1989) : 95–99. http://dx.doi.org/10.1055/s-0038-1629477.

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The aim of this study was to determine the diagnostic value of scintigraphy with 99mTc-HMPAO-labelled leukocytes for the detection of prosthetic vascular graft infection. 51 scans were recorded in 19 patients with suspected vascular graft infection and 8 control patients. Three-phase scanning was used at 0.5, 3 – 6 and 18–24 h. 13 vascular graft infections (10 early, 3 late) were found. 12 of these healed with antibiotics and only one patient with late infection had to be reoperated. None of them died during the follow-up period. The sensitivity was 100% and the specificity 96%. 99mTc-leukocyte scintigraphy seems a useful tool to detect vascular graft infection and to differentiate it from infections elsewhere. The results suggest that the incidence of vascular graft infection may be greater, and the mortality rate lower, than supposed before.

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Edwards, Norma M., Jeffrey A. Claridge, Dan H. Shell, Charles R. Handorf, Martin A. Croce et Timothy C. Fabian. « The Effect of Bacterial Contamination on Neointimal Hyperplasia in Vascular Grafts ». American Surgeon 72, n^o 12 (décembre 2006) : 1168–75. http://dx.doi.org/10.1177/000313480607201205.

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Neointimal hyperplasia (NH) is the most significant contributing factor to long-term vascular graft failure. Inflammation is known to be important in its development; however, the role of bacterial infection is unclear. We examined the effect of contamination with common organisms on the development of NH in expanded polytetrafluoroethylene grafts. Thirty adult pigs were randomized into one of four groups: no infection, contamination with Staphylococcus aureus, mucin-producing Staphylococcus epidermidis, or Pseudomonas aeruginosa. An expanded polytetrafluoroethylene graft (6 mm x 3 cm) was placed as a common iliac artery interposition graft and was inoculated with 1–2 x 108 of the selected organism before closure. Grafts were explanted 6 weeks postoperatively. Microbiologic, histological, and morphometric evaluations were performed. All grafts were patent at the time of euthanasia. The mean areas of NH were 5.45 mm2 in sterile grafts, 8.36 mm2 in S. aureus, 7.63 mm2 in S. epidermidis, and 11.52 mm2 in P. aeruginosa grafts. Comparison of means via analysis of variance showed that P. aeruginosa grafts had significantly higher formation of NH than sterile grafts (P = 0.025). NH production in infected grafts appears to be organism specific and is significantly higher with P. aeruginosa than common Gram-positive organisms. Increased NH from subclinical infection may be a significant factor contributing to late graft failures.

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Davidovic, Lazar, Dragan Vasic, Ruzica Maksimovic, Dusan Kostic, Dragan Markovic et Miroslav Markovic. « Aortobifemoral Grafting : Factors Influencing Long-Term Results ». Vascular 12, n^o 3 (mai 2004) : 171–78. http://dx.doi.org/10.1258/rsmvasc.12.3.171.

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We present the results and respective determinant factors of 283 consecutive aortobifemoral bypasses. This prospective study included 283 patients with aortoiliac atherosclerotic occlusive disease treated by aortobifemoral reconstructions. Polytetrafluoroethylene (PTFE) grafts were used in 136 patients and Dacron® grafts in 147 patients. The 30-day mortality rate was 11 patients (3.9%). Perioperative (< 30 days) graft failure occurred in 6 patients (2.1%), whereas in 14 (5.25%) patients, it occurred during the follow-up period. There were 3 (1.05%) distal anastomotic pseudoaneurysms and 5 (1.7%) graft infections, with no statistical difference between the two types of grafts. The type of prosthesis did not influence cumulative graft patency. The end-to-end configuration of proximal anastomosis and a simultaneously performed femoropopliteal bypass significantly increased the graft patency ( p < .05). The associated occlusion of the superficial femoral and popliteal arteries decreased the cumulative graft patency in comparison with that of the patients without artery disease ( p < .05). Our results showed that in the aortobifemoral position, there was no significant difference in the patency, anastomotic pseudoaneurysms, and graft infection between PTFE and Dacron grafts. However, the PTFE grafts had a significantly higher rate ( p < .05) of distal anastomotic stenosis, which was mostly caused by neointimal hyperplasia.

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Fiorani, Paolo, Francesco Speziale, Annalisa Calisti, Maria Misuraca, Davide Zaccagnini, Luigi Rizzo et Maria Fabrizia Giannoni. « Endovascular Graft Infection : Preliminary Results of an International Enquiry ». Journal of Endovascular Therapy 10, n^o 5 (octobre 2003) : 919–27. http://dx.doi.org/10.1177/152660280301000512.

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Purpose: To investigate the frequency of aortoiliac endovascular graft infections and seek the main factors influencing their development. Methods: To augment personal experience (1 case), a questionnaire was sent to 40 international centers of vascular and endovascular surgery. The literature was also reviewed to collect data on infections developing in endovascular grafts. Results: The survey (85% response rate) and literature review identified 62 cases of infected endovascular grafts (0.4% frequency of endograft infection). In 22 (35%) patients, the infection manifested initially with vague symptoms only, but 41 (65%) patients eventually presented with abdominal abscess, groin fistula, and septic embolization. Common bacteria, such as Staphylococcus aureus, were identified as the cause of most infections (54.5%). The majority (49, 79%) of the 62 patients were treated surgically; 11 (17.7%) patients received conservative therapy (no therapeutic data in 2 patients). Overall mortality was 27.4% (17/62), and operative mortality was 16.3% (8/49). Conservative treatment led to a mortality rate of 36.4% (4/11). The mean follow-up for all patients was 47.8 weeks. Possible factors influencing the development of an infection were secondary adjunctive procedures, immunosuppression, treatment of false aneurysms, and infected central lines. Conclusions: Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.

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Alam, Hasan B., Christopher Kowalski et George A. Sample. « Saphenous Vein Graft Infection ». Chest 116, n^o 6 (décembre 1999) : 1816–18. http://dx.doi.org/10.1378/chest.116.6.1816.

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Ricci, Michael A. « Late Bacteremic Graft Infection ». Annals of Vascular Surgery 5, n^o 3 (mai 1991) : 311. http://dx.doi.org/10.1007/bf02329391.

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Ward, A. S., et A. J. Russell. « Salmonella vascular graft infection ». Lancet 337, n^o 8743 (mars 1991) : 735. http://dx.doi.org/10.1016/0140-6736(91)90321-f.

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O'Brien, T., et J. Collin. « Prosthetic vascular graft infection ». British Journal of Surgery 79, n^o 12 (décembre 1992) : 1262–67. http://dx.doi.org/10.1002/bjs.1800791205.

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Holland, Fred Wilson, R. Clement Darling, Benjamin B. Chang, Dhiraj M. Shah et Robert P. Leather. « Clostridial Aortic Graft Infection ». Annals of Vascular Surgery 8, n^o 4 (juillet 1994) : 387–89. http://dx.doi.org/10.1007/bf02133003.

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Hasel, Krystal, et Tarak Patel. « Fusarium vascular graft infection ». IDCases 15 (2019) : e00511. http://dx.doi.org/10.1016/j.idcr.2019.e00511.

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Riddell, James, Kenneth J. Woodside, Matthew A. Leavitt, Duane W. Newton et Jeffery D. Punch. « Fusarium incarnatum/equiseti hemodialysis graft infection ». Infectious Disease Reports 2, n^o 2 (2 novembre 2010) : 14. http://dx.doi.org/10.4081/idr.2010.1939.

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Hemodialysis graft infections typically occur as a result of contamination by skin flora at the time of insertion or become secondarily infected after high-grade bacteremia. Infection of implanted vascular devices with filamentous fungi is rare. We report a case of infection of an implanted polytetrafluoroethylene dialysis graft with Fusarium incarnatum/equiseti that did not grow in cultures of tissue but was identified by molecular means.

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Peeters, Arne, Guy Putzeys et Lieven Thorrez. « Current Insights in the Application of Bone Grafts for Local Antibiotic Delivery in Bone Reconstruction Surgery ». Journal of Bone and Joint Infection 4, n^o 5 (15 octobre 2019) : 245–53. http://dx.doi.org/10.7150/jbji.38373.

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Abstract. Introduction: Bone implant related infection is still one of the biggest challenges in bone and joint surgery. Antibiotic impregnated bone grafts seem to be promising in both treatment and prevention of these infections. However, great variance in methodology predominates this field of research. This paper gives an overview of the published literature.Methods: The PRISMA-flowchart was used as protocol for article selection. Medline was searched and articles were selected in accordance with predetermined exclusion criteria.Results: Forty-eight articles were included in the synthesis. Topics including bone graft type, manipulations of the graft, elution profile, bacterial inhibition, osteotoxicity, incorporation, special impregnation methods, clinical use and storage were investigated.Therapeutically, high initial levels seem appropriate for biofilm eradication. A single stage procedure in the treatment of bone implant related infection seems feasible. Prophylactically, the literature indicates a reduction of postoperative infections when using antibiotic impregnated bone grafts.Conclusion: Bone grafts are a suitable carrier for local antibiotic application both therapeutically and prophylactically.

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Ayus, J. C., et D. Sheikh-Hamad. « Silent infection in clotted hemodialysis access grafts. » Journal of the American Society of Nephrology 9, n^o 7 (juillet 1998) : 1314–17. http://dx.doi.org/10.1681/asn.v971314.

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Thrombotic and infectious complications are frequent causes of hemodialysis vascular access failure and contribute considerably to the cost of care for chronic hemodialysis patients. Although there is clear indication for removal of patent grafts in unresolved bacteremia, there are no guidelines for the management of clotted nonfunctioning grafts. To evaluate for the existence and clinical relevance of silent infection in clotted nonfunctioning hemodialysis grafts, a study was conducted with a series of 20 hemodialysis patients who presented with fever (15 patients), or fever and clinical signs of sepsis (five patients), in whom the source of infection was not immediately localized to any organ system. Comparison was made with 21 asymptomatic patients with clotted grafts who served as control subjects. All patients and control subjects came from a pool of 115 chronic hemodialysis patients in an outpatient hemodialysis unit in the Houston metropolitan area, who were on hemodialysis for a period of time ranging from 3 to 15 yr. Indium scans were performed, followed by removal of the clotted grafts in all patients and control subjects. Bacterial cultures of the recovered surgical material and blood were done concomitantly in all study participants. Indium scans showed positive uptake in or around the clotted grafts in all of the patients and in 15 of the control subjects. Purulent material was found in the grafts in all patients and in 13 of 15 indium scan-positive control subjects. When positive, blood culture pathogens were identical to those cultured from the graft material in all instances. The predominant pathogens were Staphylococcus aureus, followed by Staphylococcus epidermidis. There was no evidence of graft infection in the control subjects if indium scan was negative. Chart review dating back to the start of dialysis revealed five past infectious episodes in the patient group, compared with four in the control group. These findings suggest that clotted nonfunctioning grafts are frequent harbingers of infection. They should be suspected as the source of infection in every hemodialysis patient that presents with fever, even in the absence of clinical signs of graft site infection.

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Yoshida, Takeshi, Bunpachi Kakii, Masato Furui et Gaku Uchino. « Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection ». Thoracic and Cardiovascular Surgeon 66, n^o 03 (20 février 2018) : 227–32. http://dx.doi.org/10.1055/s-0038-1623479.

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Objective Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection. Methods This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017. Results There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%). Conclusions Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement.

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Torsello, G., et W. Sandmann. « Use of antibiotic-bonded grafts in vascular graft infection ». European Journal of Vascular and Endovascular Surgery 14 (décembre 1997) : 84–87. http://dx.doi.org/10.1016/s1078-5884(97)80161-x.

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Figueroa, Francisco, David Figueroa, Rafael Calvo, Alex Vaisman et João Espregueira-Mendes. « Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction : a narrative review ». EFORT Open Reviews 6, n^o 3 (mars 2021) : 211–16. http://dx.doi.org/10.1302/2058-5241.6.200059.

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Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059

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